Clinical implications of changes in hepatic drug metabolism in older people

Sarah N Hilmer¹, Gillian M Shenfield², David G Le Couteur¹

¹Centre for Education and Research on Ageing and Anzac Research Institute, University of Sydney, Concord RG Hospital, Concord, NSW, Australia; ²Department of Clinical Pharmacology, Royal North Shore Hospital, St Leonards, NSW, Australia

Abstract: Prescribing for older people is challenging because of the paucity of clinical trial evidence of therapeutic benefit in this population and the presence of evidence that older people are at increased risk of adverse drug reactions. The outcomes of pharmacotherapies in older people depend on age-related changes in both pharmacokinetics and pharmacodynamics. Of the pharmacokinetic changes, those in hepatic metabolism are the most significant. Recent advances in biogerontology have improved our understanding of changes that occur in hepatic pharmacokinetics in older people. Knowledge of age-related changes in hepatic metabolism can guide prescribing and help reduce the risk–benefit ratio of using medications in older people.

Keywords: aging, pharmacokinetics, liver, adverse drug reactions, prescribing